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Eligibility requirements for PriorityMedicare 2008 plans

Please read this information on the eligibility requirements for our PriorityMedicareSM Medicare Advantage plans (PriorityMedicare ValueSM, PriorityMedicareSM and PriorityMedicare PlusSM) and for our prescription coverage only plan (PriorityMedicare RxSM).

Note: Plans may change year to year.
  • We review our plans annually at Priority Health. We may make adjustments to ensure that we're providing the coverage you need at an affordable price.
  • Effective January 1 of each year there may be changes to plan benefits, our approved drug list, our pharmacy network, the counties where we offer plans and/or our monthly premiums, copays and coinsurance.
  • We'll send you information about upcoming changes in October of each year to give you time to review them before the annual enrollment period November 15 - December 31.

Medicare Advantage plans

Priority Health offers three Medicare Advantage plans: PriorityMedicare Value, PriorityMedicare and PriorityMedicare Plus.

To apply for any of these plans:
  • You must be entitled to Medicare Part A and enrolled in Part B.
  • You must continue to pay your monthly Part B premium unless it's paid for by Medicaid or another third party.
  • You must live in one of these 19 Michigan counties to join.
Allegan, Antrim, Barry, Benzie, Crawford, Grand Traverse, Kalkaska, Kent, Leelanau, Manistee, Missaukee, Montcalm, Muskegon, Newago, Oceana, Osceola, Ottawa, Roscommon   or Wexford. If your employer offers one of these plans, you may be able to join even if you live outside these counties. Contact your employer. 

Additional information
  • These three plans are health maintenance organizations (HMOs) with a point-of-service option operating under a Medicare Advantage contract. They include Medicare Part D Prescription Drug Plan coverage.
  • The prescription drug benefit is only available to members of these plans. If you're already enrolled in another Medicare Advantage Prescription Drug Plan, you must receive your drug benefit through that plan.
  • You must use in-network health care providers to receive full plan benefits, except for emergency circumstances, post-stabilization care and renal dialysis. You can see non-network providers but depending on the PriorityMedicare plan you have, you may have to pay 20% or 30% for coinsurance and an initial deductible of $500 for Medicare-covered services (PriorityMedicare Value plan only).  Some services require authorization in advance.

Prescription-drug-coverage-only plan

PriorityMedicare Rx is a Medicare Part D Prescription Drug Plan operating under a contract with the federal government. This plan offers no medical benefits, such as hospitalization or doctor visits.

To apply for this plan:
  • You must be entitled to Medicare Part A and/or enrolled in Part B.
  • If you're enrolled in Medicare Part B, you must continue to pay your monthly Part B premium unless it's otherwise paid for under Medicaid or by another third party.
  • You must be a resident of the state of Michigan.
  • You can only be enrolled in one Part D plan at a time.
  • If you're enrolled in a Medicare Advantage coordinated care (HMO or PPO) plan or a Medicare Advantage private fee-for-service (PFFS) plan that includes Medicare prescription drugs, you may not enroll in a separate Prescription Drug Plan unless you first disenroll from the HMO, PPO or PFFS plan.
  • If you're enrolled in a PFFS plan that does not provide Medicare prescription drug coverage or an Medicare Advantage Medical Savings Account (MSA) plan, you may enroll in a Prescription Drug Plan. Also, if you're enrolled in an 1876 Cost Plan, you may enroll in a Prescription Drug Plan.

All PriorityMedicare plans


Using network pharmacies

  • You must use PriorityMedicare network pharmacies to receive full plan benefits.
  • If you use a non-network pharmacy, you'll be required to pay up front. You may then a file a claim form for reimbursement. We'll reimburse you for what you paid up to our negotiated in-network pharmacy cost, less your copay or coinsurance amount.
  • Our pharmacy network includes retail, mail order, Long-Term Care (LTC), Indian Health Service/Tribal/Urban Indian Health Program (I/T/U) and Home Infusion pharmacies. See our online pharmacy directory. Note: Clicking this link will take you away from the PriorityMedicare section of the Priority Health website.
  • For information on using our mail-order pharmacy service call Customer Service. You can also contact us by e-mail or regular mail.

Additional information

For more information about any PriorityMedicare plan:

  • Call 616 464-8850 or toll-free 888 389-6676
Hearing- or speech-impaired TTY/TDD: 616 464-8485, or toll-free 888 551-6761
(8:00 a.m.-8:00 p.m. Eastern time, 7 days a week)

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Last modified 05/12/08